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Today it was announced that Nottingham University Hospitals trust was being placed in ‘special measures’ by the CQC following an inspection over the summer. The trust was also downgraded from ‘good’ to ‘requires improvement’.
The changes are unsurprising given that the maternity services were rated as ‘inadequate’ last year after the regulator uncovered deep-rooted cultural problems within the service.
The most recent inspection was focused on surgical and urgent and emergency services. While the trust was praised for “good practices” in the surgical department, urgent and emergency received similar criticisms around culture and leadership as the maternity department.
Perhaps one of the most concerning aspects of the inspection, although sadly not unique to this trust, were reports of a ‘culture of bullying’ where staff were too afraid to speak up about poor treatment. Racial discrimination was also raised as a concern - but despite this a member of the executive team told inspectors they were not aware of any bullying issues.
This lack of awareness explains why inspectors also raised concerns about leadership, citing a “disconnect” between the board and wider organisation.
It’s fair that criticisms of some aspects of care, such as waiting times for initial assessments in the emergency department, can be blamed on covid pressures.
But if the trust wants to retain staff in order to cope with rising demand then the culture issue needs to be addressed urgently.
Fall from grace
Embattled Essex Partnership University Foundation Trust has seen its ratings for children’s wards drop from “outstanding” to “inadequate”.
The mental health trust – which is is aready undergoing an inquiry into a string of adult patient deaths – was also issued with an “urgent enforcement action” notice after identifying safety concerns in its child and adolescent inpatient services. The notice requires the provider to get written permission from the regulator and demonstrate safe staffing levels before it can admit any new patients.
The regulator’s key concerns related to low staffing levels and high levels of agency staff. In one instance, the CQC found a patient could not return from leave, despite needing care, due to staffing shortages. Staff reportedly told the patient they would have to wait until the evening and, if their mental health became “unmanageable”, they should attend accident and emergency.
The trust is already subject to an independent inquiry into a string of deaths which occurred across its adult inpatient units between 2000 and 2020.